基底节区EPVS对AIS患者rt-PA静脉溶栓后近期预后的影响  

Effects of Basal Ganglia EPVS on Short-Term Prognosis of Patients with AIS After Intravenous Thrombolysis with rt-PA

作　　者：张贺川 周贺民 冯文献 ZHANG Hechuan;ZHOU Hemin;FENG Wenxian(Emergency Department,Zhumadian Central Hospital,Zhumadian 463000,China;Emergency Intensive Care Department,Zhumadian Central Hospital,Zhumadian 463000,China;Neurointerventional Department,Zhumadian Central Hospital,Zhumadian 463000,China)

机构地区：[1]驻马店市中心医院急诊科,河南驻马店463000 [2]驻马店市中心医院急诊重症监护科,河南驻马店463000 [3]驻马店市中心医院神经介入科,河南驻马店463000

出　　处：《河南医学研究》2024年第21期3892-3895,共4页Henan Medical Research

摘　　要：目的探讨基底节区(BG)扩大的血管周围间隙(EPVS)对急性缺血性脑卒中(AIS)患者接受人类重组组织型纤溶酶原激活物(rt-PA)静脉溶栓后近期预后的影响。方法选取2021年3月至2022年3月于驻马店市中心医院接受rt-PA静脉溶栓治疗的101例AIS患者作为研究对象。所有患者经MRI检查后,进行EPVS数量计分,按EPVS评分划分严重程度:0~1分为无或轻度组,2~4分为重度组。根据改良Rankin(mRS)评分量表进行预后评估。整理随访资料,统计90 d内101例患者近期预后,采用logistic回归分析影响AIS患者近期预后的相关因素。结果101例AIS患者经早期rt-PA静脉溶栓治疗后90 d内,3例发生死亡;有67例患者的mRS评分为0~12分(转归良好组);31例患者的mRS评分为3~5分(转归不良组)。转归良好组年龄≥60岁、吸烟史、合并心房颤动、BG-EPVS评分重度、发病至溶栓时间≥4.5 h者高于转归不良组,差异有统计学意义(P<0.05);两组性别、饮酒、合并高血压、合并高脂血症、梗死部位比较,差异无统计学意义(P>0.05)。进一步经过logistic回归分析,结果显示年龄≥60岁、BG-EPVS评分为重度及发病至溶栓时间≥4.5 h与年龄<60岁、BG-EPVS评分为无/轻度及发病至溶栓时间<4.5 h相比较,前者导致预后不良的风险分别高达1.919倍、1.5151倍及1.436倍(P<0.001)。结论BG-EPVS评分较高的AIS患者接受rt-PA静脉溶栓后近期预后不良风险相对更高;通过计算BG-EPVS评分,对临床评估AIS溶栓治疗近期预后并建立积极干预方案具有一定的指导价值。Objective To evaluate the effects of enlarged perivascular spaces(EPVS)from basal ganglia(BG)on short-term prognosis of patients with acute ischemic stroke(AIS)after intravenous thrombolysis with human recombinant tissue plasminogen activator(rt-PA).Methods A total of 101 patients with AIS who received intravenous thrombolytic therapy with rt-PA in Zhumadian Central Hospital from March 2021 to March 2022 were selected as subjects.After MRI examination,all patients were scored for the number of EPVS,and the severity was divided according to the EPVS score:0-1 points were classified as no or mild group,2-4 points were classified as severe group.Prognostic evaluation was conducted based on the improved Rankin(mRS)scoring scale.Follow-up data were compiled,and the short-term prognosis of 101 patients within 90 days was counted,and logistic regression was used to analyze the related factors affecting the short-term prognosis of patients with AIS.Results Within 90 days after early rt-PA intravenous thrombolysis treatment,3 out of 101 AIS patients died,67 patients had the mRS scores of 0-12 points(in the group with good prognosis),the mRS score of 31 patients were 3-5 points(poor prognosis group).The group with good prognosis had a higher age of≥60 years,smoking history,concomitant atrial fibrillation,severe BG-EPVS score,and a time from onset to thrombolysis of≥4.5 hours compared to the group with poor prognosis(P<0.05).There was no statistically significant difference between the two groups in terms of gender,alcohol consumption,concomitant hypertension,concomitant hyperlipidemia,and infarct site(P>0.05).The results showed that age≥60 years,severe BG-EPVS score,and onset to thrombolysis time≥4.5 hours were associated with 1.919 times,1.5151 times,and 1.436 times higher risks of poor prognosis compared to age<60 years,no/mild BG-EPVS score,and onset to thrombolysis time<4.5 hours,respectively(P<0.001).Conclusion AIS patients with higher BG-EPVS scores have a relatively higher risk of poor short-term prognosis a

关 键 词：急性缺血性脑卒中 基底节区 血管周围间隙 

分 类 号：R743.3[医药卫生—神经病学与精神病学]